I have a son who is 7. He failed to toilet train and continues to have difficulty with bowel incontinence. Sometimes able to urinate in proper manner. No other known health issues. He does not seem gassy or report any bloating or pain. Has had an inconclusive MRI looking for sacral abnormalities. Ultrasound was negative. X-ray found some backing-up of his large intestine but no complaints from him of discomfort. He has a normal appetite. When given a Miralax type laxative, he became ill and began vomiting badly and looked sickly so we stopped that treatment. He is in big kid pull-ups that were prescribed by family doctor. He reports that he cannot feel onset of bowel movements. He has had 1 year of OT treatment and 12 sessions of psychiatric counseling. All treatments and attempts to toilet train have failed. He is 2 school grades advanced in academic testing so it is not a question of intelligence nor does he have any physical delays that would prevent him from using the bathroom. We are wondering what to do next if there is a more specific direction we should be working towards. We have no real diagnosis yet as to the cause of his condition. What area of medical practice should we try next?